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Good EnoughPeer-ReviewedeClinicalMedicine2023
Arts-literacy intervention for adolescent depression and anxiety
An arts-literacy intervention for adolescent depression and anxiety symptoms: outcomes of a randomised controlled trial of Pre-Texts with Kenyan adolescents
Key Finding
A randomized trial of 235 Kenyan adolescents found that Pre-Texts, an arts-literacy intervention involving text-inspired artmaking and reflection, produced greater reductions in depression (d = 0.52) and anxiety (d = 0.51) at 1-month follow-up.
At a Glance
Study Design
Randomized controlled trial
Sample Size
N=235
Population
Kenyan adolescents 13-19
Setting
Kenyan high schools
Abstract
Background Mental health problems are prevalent among youth in low-resource countries and are further compounded by stigma and limited access to traditional treatments. The need for scalable, accessible, and stigma-free mental health interventions is urgent. We developed and tested Pre-Texts, an arts-literacy intervention that targets adolescent depression and anxiety, in Kenya.
Methods We conducted a universal RCT (Randomized Controlled Trial). Students from Kenyan high schools (N = 235, ages 13–19, 53.19% female) were randomized to either Pre-Texts or a study skills control intervention. Pre-Texts involves the use of a text—such an excerpt from a novel, a physics lesson, or a technical manual—to inspire art-making that is followed by collective reflection on the process of interpretation through art-making. Participants met daily for a week in groups of 6–12 youths for 1-h sessions. Groups were facilitated by high school graduates trained as lay-providers. This study was pre-registered at the Pan African Clinical Trials Registry (PACTR; registration number: PACTR202111497122432). The trial took place between August 11th 2021 and December 18th 2021.
Findings Pre-Texts produced a greater reduction in depression (d = 0.52, 95% CI [0.19, 0.84]) and anxiety (d = 0.51, 95% CI [0.20, 0.81]) symptoms from baseline to 1-month follow-up compared to the control group. Similarly, in a subsample of participants with elevated depression and anxiety symptoms, Pre-Texts produced a greater reduction in depression (d = 1.10, 95% CI [0.46, 1.75]) and anxiety (d = 0.54, 95% CI [−0.07, 1.45]) symptoms.
Interpretation Our findings suggest that a brief arts-literacy intervention with challenging school material in a group setting, implemented as an afterschool program, can reduce depression and anxiety symptoms in adolescents in Sub-Saharan Africa. Future replication trials with larger sample sizes with extended follow-ups will help assess the strength and sustainability of these effects.
Methods We conducted a universal RCT (Randomized Controlled Trial). Students from Kenyan high schools (N = 235, ages 13–19, 53.19% female) were randomized to either Pre-Texts or a study skills control intervention. Pre-Texts involves the use of a text—such an excerpt from a novel, a physics lesson, or a technical manual—to inspire art-making that is followed by collective reflection on the process of interpretation through art-making. Participants met daily for a week in groups of 6–12 youths for 1-h sessions. Groups were facilitated by high school graduates trained as lay-providers. This study was pre-registered at the Pan African Clinical Trials Registry (PACTR; registration number: PACTR202111497122432). The trial took place between August 11th 2021 and December 18th 2021.
Findings Pre-Texts produced a greater reduction in depression (d = 0.52, 95% CI [0.19, 0.84]) and anxiety (d = 0.51, 95% CI [0.20, 0.81]) symptoms from baseline to 1-month follow-up compared to the control group. Similarly, in a subsample of participants with elevated depression and anxiety symptoms, Pre-Texts produced a greater reduction in depression (d = 1.10, 95% CI [0.46, 1.75]) and anxiety (d = 0.54, 95% CI [−0.07, 1.45]) symptoms.
Interpretation Our findings suggest that a brief arts-literacy intervention with challenging school material in a group setting, implemented as an afterschool program, can reduce depression and anxiety symptoms in adolescents in Sub-Saharan Africa. Future replication trials with larger sample sizes with extended follow-ups will help assess the strength and sustainability of these effects.
Authors
Osborn, T. L., Ndetei, D. M., Sacco, P. L., Mutiso, V., Sommer, D.
Citation & Access
Osborn, T. L., Ndetei, D. M., Sacco, P. L., Mutiso, V., Sommer, D. (2023). An arts-literacy intervention for adolescent depression and anxiety symptoms: outcomes of a randomised controlled trial of Pre-Texts with Kenyan adolescents. eClinicalMedicine.